I heard on the radio this morning that the BMA wants to eliminate the private sector from the NHS.
Blimey, I thought, does that mean that all doctors are going to become direct employees of the NHS and stop doing private work using NHS facilities?
Don’t be silly, Rick. They don’t mean that private sector. They’re talking about the other private sector; that of managers, private companies, targets and other horrid things.
In certain respects the BMA has a point. When the PFI chickens come home to roost, the taxpayers of tomorrow may well find that they have been left to pick up the tab for today’s profligate spending.
But has the introduction of market reforms and private sector suppliers really been so bad for the NHS? As I noted last month, the comparison between the NHS in Wales and Scotland, where there is no purchaser-provider split, and their localised and more market-driven English counterpart, doesn’t support the BMA’s stance.
The performance of the NHS has improved at a faster rate in England than in Scotland and Wales. While some of this this might be due to what Imperial College’s Carol Propper calls “the terror of targets”, it makes it hard to hold up those parts of the NHS with no private provision as models of success. As the FT said:
The English NHS is hitting a maximum 18-week wait for treatment that Scotland will not achieve until 2011.
Waits are worse in Wales, and a few years ago a Welsh Audit Office report noted that the poorer overall health of the Welsh population did not explain the performance. Northern parts of England, it noted, had similar health status “but have consistently delivered more healthcare at lower cost”.
When challenged on Radio 4 by the CBI’s Susan Anderson, Hamish Meldrum, Chairman of the BMA, could not offer much evidence against private sector involvement in the NHS, apart from PFI and the usual target; “all those management consultants”.
I was reminded of something I read earlier this week, in a completely different context, on Penny Red’s blog:
[I]t is a great horror to discover that you yourself are part of the overclass and yet to feel that you are not enjoying any special privileges because of it. The nature of privilege, of course, is that it is taken for granted….
I wonder if the BMA’s demand to kick the private sector out of the NHS could roughly be translated as something like this:
Back in the good old days, we doctors ran the hospitals. Quite rightly, no-one questioned what we did and we were treated with the courtesy and respect due to us. Now, we are being told what to do by these jumped up managers with their vulgar business-speak. It’s just not bloody fair!
The cries of once unassailable elites as they feel their power being usurped by upstart challengers is a recurring theme throughout history. History also tells us that such elites never give up their power without a fight. And it looks very much as though a big fight is coming sometime in the next few years.
